The Unkindest Cut

Some teens resort to self-harming behaviors to cope with life and to release the pain.

Alana’s parents knew something was amiss with their daughter. She seemed sad, more withdrawn than before, but whenever they tried to talk to her, she said things were fine. When winter turned to spring, they noticed she was still wearing sweatshirts despite the warmer weather.

A friend whose daughter had gone through a similar experience suggested that the long sleeves could be a sign that Alana was cutting herself. When they gently confronted her, Alana broke down and admitted she had been using old razors to cut her arms.

“It was shocking at first, foreign to us,” said Alana’s mother, Lori. “It’s emotionally hard to see your child struggling so much they’re hurting themselves.”

Lori and her husband immediately reached out to find help for their daughter, who is now 16. She began working with a therapist to address the issues that had caused her to cut herself.

“I was really depressed, and I needed a coping mechanism,” said Alana, who started cutting when she was 13. “I knew and saw other people who did it, so I tried and it helped, so I kept doing it. It was a way to release everything.”

While Alana, who also struggles with Obsessive-Compulsive Disorder (OCD), was able to stop harming herself temporarily, she would eventually relapse and resume cutting. Things came to a head when she was discovered cutting herself at summer camp. The camp director called her parents and asked them to pick her up. Once she got home, she worked with a new therapist and attended an intensive outpatient program. With the help of her therapists and the support of her parents, Alana was able to stop cutting herself and find healthy alternatives to cope with her feelings.

What Is Self-Harm?

The clinical term for cutting and other types of self-harm is “non-suicidal self-injury,” or NSSI. It is characterized by deliberate self-inflicted harm that isn’t intended to be suicidal. While cutting is a common form, other types of self-harm include burning, hitting, embedding objects under the skin or other behaviors intended to cause pain.

Carolyn Daitch

“It (self-harm) usually starts in adolescence, middle or high school, as a way of making pain concrete,” said psychotherapist Dr. Carolyn Daitch, director of the Center for the Treatment of Anxiety Disorders in Farmington Hills. “If one is experiencing emotional pain they can’t label, it can feel like a release to feel physical pain. Unfortunately, after they do it, they can feel shame.”

Daitch said self-harm can be related to trauma but is more often a reaction to emotional stress, vulnerability and the inability to manage strong feelings. One of the dangers is that the behavior becomes habitual and, therefore, difficult to stop, as in Alana’s case.

“It can become a habit, and we’re vulnerable to habits,” Daitch explains. “It can become compulsive. The person starts to experience a feeling of release and does it again and again.”

Daitch adds that self-harm can become contagious among groups of friends.

“These things can be modeled,” she says. “When they see it, it gets in their range of possibilities.”

The most frequent sites of self-injury are the hands, wrists, arms, stomach and legs. Cutting or burning can result in serious injuries or infections, but the majority of self-injurers do not seek medical treatment because of the shame and stigma associated with the disorder.

In a study published by JAMA (Journal of the American Medical Association), among girls 10 to 14 years old, rates of emergency room visits for treatment of self-harm surged 18.8 percent yearly between 2009 and 2015. Researchers noted that, because this study included only those who visited an emergency room, the actual rates of young teens engaging in self-harm are likely many times higher.

While many parents worry that their child who is self-harming may be suicidal, this is usually not the case.

“My experience is that kids cut to relieve tension or pain,” said psychotherapist Dr. Erin M. Hawks, an assistant professor at the University of Oklahoma with family ties to Detroit. “It is usually not associated with a greater risk of suicide. Cutting helps kids feel in control of their pain when they feel their lives are out of control. They cut to relieve pain not to die.”

Others cut to punish themselves when they feel guilty, warranted or not.

Who Self Injures?

While the majority of young people who harm themselves are female, males also engage in this behavior although in different ways. While girls are more likely to engage in cutting, boys are more prone to deliberately bruising themselves or having others hurt them.

According to the National Institutes of Health, recent studies have found that one-third to one-half of adolescents in the U.S. have engaged in some type of non-suicidal self-harm. Young people who are bullied or otherwise rejected by peers are more likely to injure themselves than others. Those who consider themselves part of a sexual minority, such as gay or bisexual, especially females, also have a higher rate of self-injurious behavior.

Rachel’s Story

Rachel remembers trying to hurt herself when she was only 5 years old, running into walls, throwing herself down the stairs and banging her head against the windows. Her self-harm, which was accompanied by suicidal thoughts, progressed throughout her childhood and into her teenage years.

“Self-harm became my best friend,” she said. “Someone who I could always turn to whether I was happy, sad, bored or upset. Blood became my favorite color.”

After finally working up the courage to tell her mother she needed help, Rachel spent time as an inpatient in a psychiatric hospital and participated in an intensive outpatient program. When she got out, things had not improved.

“It didn’t soothe my pain. Things only got worse. I was 16 when I grabbed a lighter and a fork and burned myself,” said Rachel.

Rachel’s downward spiral continued, even after another inpatient stay and subsequent outpatient program.

“Self-harm became my best friend. Someone who I could always turn to whether I was happy, sad, bored or upset. Blood became my favorite color.” — Rachel

“I came home and became addicted to giving myself third-degree burns. No one could stop me, not even myself. This was my new reality for a year,” she said. “In school, I would leave class and choke myself in the bathroom. I would hold my breath in class until my eyes would bulge out. There was no safe place for me here on Earth.”

Her mother found her another inpatient treatment program, where Rachel continued to hurt herself despite stringent monitoring by the staff. Then one day, something changed. During a group therapy session, Rachel realized that, despite her suicidal thoughts, she did not want to die. Her therapist asked her to let go of the thoughts that led her to hurt herself. She decided to give it a try.

Rachel commemorates May 1, 2017, as the day she stopped harming herself.

“I took it day by day. Minute by minute. I was mourning a loss,” she said.

She lost the will to burn herself. Instead, she used meditation and deep breathing to manage her feelings. She trained herself to daydream about positive things, visualizing herself running through meadows and swimming in calm rivers. Today, she is happier than she has ever been, something she thought impossible little more than a year ago.

“Recovery isn’t a straight line … everybody can recover,” she says. “You have to be willing, open and honest. Don’t hide anymore.”

Parents’ Perspective

How To Help

These suggestions were compiled by professionals and parents of teens who have engaged in self-harm:

• If a friend suspects self-harm is occurring, try to persuade the person to tell her parents or another trusted adult. If they refuse, then tell her parents or a school counselor, teacher or rabbi.

• Parents should reach out immediately to make an appointment with a mental health professional.

• If wounds are present, make an appointment with the child’s primary care physician for an examination. If the child is bleeding or the wounds appear infected, take the child or teen to the emergency room or urgent care.

• Stay close to your kids, keep apprised of what is going on at school or with their friends.

• Don’t be afraid to talk about self-harm, even if the child doesn’t want to talk about it.

• Parents need to plant the seed that the feelings their kids are experiencing will pass. Children and teens do not realize that things will get better and that their feelings and situations will change.

• Keep the lines of communication open. If they say things are fine or under control, don’t be afraid to ask “how” they are handling things.

According to Daitch, Alana’s parents responded in the most beneficial way: They arranged to get help for their daughter while remaining supportive, calm and non-judgmental.

Daitch acknowledges this is difficult for many parents; but reacting with horror or panic can cause more damage by eliciting fear and shame in the teen.

“It’s important for the parent to stay calm,” Daitch says. “It’s distressful to see your child suffering, alarm bells can go off with cutting, but it’s important for parents to regulate their emotions. If they (the teens) feel they’re upsetting their parents, they may not be as open.”

While parents may initially feel guilty if they were unaware of the behavior, Daitch stresses that self-harm is a mental health issue and not the result of bad parenting.

“It’s nobody’s fault; mental illnesses run in families,” Daitch says, explaining that self-harm can be triggered by depression, anxiety or other conditions such as OCD related to bipolar disorder. “It doesn’t mean you are bad parents.”

One mother, Sherri, learned her daughter was cutting herself when she arrived home one day and found her daughter with dozens of small, superficial cuts on her legs and two deeper cuts (made accidentally) that required stitches.

“I was shocked and saddened by this, and I wanted to help her,” she said.

At the hospital, questions from the medical professionals caused Sherri to feel ashamed and embarrassed that she was unaware her daughter was engaging in this behavior.

“I have a close relationship with my daughter and she was seeing a therapist for anxiety and stress, but she was hiding this behavior at home under long sleeves and pants,” said Sherri (not her real name).

One father learned years later that his now-35-year-old daughter was cutting herself during high school. She has since stopped the behavior and gotten treatment for the depression and anxiety that caused her to harm herself, but her father still regrets being unable to help her at the time.

Signs of Self-Harm

• A group of small linear cuts or bruises grouped on the arms or legs

• Several bandages in one place that cannot be attributed to a single incident or injury

• Long pants or long sleeves in warm weather, clothes that cover more areas of the skin than would be appropriate for current temperatures

• Hiding the body while dressing or changing clothes — adolescents often cut in hidden areas like their inner thighs or stomachs, so if your teen suddenly refuses to change in front of you, it could be a red flag.

• Traces of blood in bathrooms and bedrooms

• Online computer history contains websites that are proponents for cutting and self-harm

• Changes in mood, withdrawing from friends or avoiding things they used to enjoy

• Changes in eating habits; eating disorders can be concurrent with self-harm.

“When I finally found out, I felt really sad and sorry that I didn’t know what she was going through,” he said.

While Alana’s parents were initially shocked to learn their daughter was cutting herself, they knew they had to stay calm to give her the support she needed.

“We understand that mental illness is a disease; it’s not a character flaw, and it’s not in her control,” Lori said. “Not all parents do understand that. It’s not who she is, but something she has, and she knows we feel that way.”

Coping strategies

Daitch teaches her clients several self-soothing techniques, which are especially helpful with impulse-control issues such as cutting. She believes teens engage in self-harm for different reasons that include frustration, sadness, anxiety, stress over school and other issues. Being able to label the feelings and tolerate difficult emotions is key to managing feelings without resorting to self-harm.

Alana’s therapist also offered her strategies for managing anxiety, such as taking a bath, listening to music or even holding ice cubes to ward off panicky feelings.

“I’m happy to hear the sound of the bath because it means she’s coping,” Lori said. “She’s finding healthy coping mechanisms, and she’s really enjoying learning what can help.”

Editor’s note: Anonymous names were used in this story. However, “Alana” and her mother, “Lori,” say they are available to anyone struggling with this issue who would like to talk with them. To reach out to them, contact writer Ronelle Grier at ronellegrier@gmail.com.